A Pott’s Puffy Tumor Associated with Epidural - Cutaneous Fistula and Epidural Abscess: Case Report

BACKGROUND: Pott’s puffy tumour is characterized by a fluctuate swelling of the frontal region as a result of osteomyelitis of the frontal bone. This inflammatory lesion may propagate endocranially, resulting in acute meningitis, epidural abscess, subdural empyema, cavernous sinus trombophlebitis, cerebritis, and frontal lobe abscess of the brain. CASE REPORT: We present an unusual case of a 33-year-old man suffering from Pott’s puffy tumour whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess. We confirmed the diagnosis by contrast-enhanced computed tomography scanning and magnetic resonance imaging of the head. After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous lesion. The treatment was prolonged with four weeks’ antibiotic administration. CONCLUSION: Subperiosteal abscess of the frontal bone is an extremely rare complication of frontal sinusitis. This lesion may propagate endocranially, resulting in dangerous intracranial inflammatory lesions. Early diagnosis, medication and surgical therapy are very important in reducing morbidity and mortality.